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[DYSPHAGIA] More acromeglia & stroke.
- Subject: [DYSPHAGIA] More acromeglia & stroke.
- From: pnbslp@hotmail.com (Philip Beck)
- Date: Fri, 02 Mar 2001 10:41:25 -0400
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<P>Thanks for your input... </P>
<P><FONT style="BACKGROUND-COLOR: #ffffff">1) </FONT>Regarding hyoid displacement, it appears that there was adequate elevation (I use the height of 1 vertebral body as a guide, but I know of no evidence to support this except my own experience with normals) but I have no "yardstick" to measure anterior movement. I thought that the extended swallow would assist in prolonging the duration of UES opening, but this did not help. I suggested manometry early on in managing this case, but it appears to have been ignored. How do you measure "adequate" laryngeal movement? </P>
<P>2) Although the stroke has clearly made things worse, this man definitely had a preexisting condition. The acromeglia was the most significant condition at the time, although "silent" strokes are a possibility. </P>
<P>3) The CAT scan did show a brain stem infarct and I am trying to reach the neurologist and GI doc</P>
<P>4) I suspected UES dysfunction because of the small proportion of the bolus entering the esophagus and the severe piriform sinus residue in the presence of apparently adequate hyoid excursion and visible tongue base- posterior pharyngeal wall opposition (I presume that weakness here can only be inferred unless proven otherwise by manometry?) I don't know why a J tube was selected over a G tube (re: LES status) but will follow up on that as well</P>
<P>5) An interesting note - the GI doc suggested we repeat the MBS with solids.</P>
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<P>Thanks, Philip</P>
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<P> </P></DIV><br clear=all><hr>Get Your Private, Free E-mail from MSN Hotmail at <a href="http://www.hotmail.com";>http://www.hotmail.com</a>.<br></p></html>
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